BC_17-15_ Marsh (2)

Brunswick County
Local Government
Lf
CAMA
MINOR DEVELOPMENT
P-yud BC17.15
Permit Number
Coastal Management
ENVIRONMENTAL QUALITY
as authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission for development in an area of environmental
concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area Management"
Issued to Joseph Marsh, authorizing development in the Estuarine Shore Area of Environmental Concern (AEC) at 431
Ironwood Drive SE in Bolivia NC 28422, as requested in the permittee's application package, dated 29-Sep-17 and
received complete 29-Sep-17. This permit, issued on 10-Oct-17, is subject to compliance with the application and site
drawing (where consistent with the permit), all applicable regulations and special conditions and notes set forth below.
Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may cause the permit to be
null and void.
This permit authorizes: Single Family Residence/Driveway.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 29-Sep-17.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal
regulations, applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-
evaluation and modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final
inspection at completion of work. -
.r_
�`"v'Ct.
(Additional Permit Conditions on Page 2) ACM WILMINGTON
O C T 12 2011
This permit must be on the project site and accessible to the permit officer when
the project is inspected for compliance. Any maintenance work or project
modification not covered under this permit, require further written permit
approval. All work must cease when this permit expires on:
December 31, 2020
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal
Management.
Connie Marlowe
CAMA Local Permit Official
PO Box 249
Bolivia, NC 28422
PERMITTEE
(Signature required if conditions above apply to permit)

Name: Joseph Marsh
Minor Permit # BC17-15
Date:10-Oct-17
Page 2
(5) The amount of impervious surface shall not exceed 30% of the lot area within 75 feet of Normal High Water
(Estuarine Shoreline Area of Environmental Concern), in this case 850 square feet is authorized.
(6) Unless specifically allowed in 15A NCAC 07H-0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of Normal High Water. No portion of the
roof overhang shall encroach into the 30 foot buffer.
(7) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line of filter cloth must
be installed between the land disturbing activity and the adjacent marsh or water areas, until such time as the area
has been properly stabilized with a vegetative cover.
(8) Any proposed for grading within the 30' buffer from the Normal High Water level must be contoured to prevent
additional stormwater runoff to the adjacent marsh. This area shall be immediately vegetatively stabilized, and must
remain in a vegetated state.
(9) All other disturbed areas shall be vegetatively stabilized (planted and mulched) within 14 days of construction
completion.
SIGNATURE:
PERMITTEE
DATE:
DCM WILMINGTON, NC
OCT 12 2011

Locality
rJYL„KsW ick CQl U'i
Permit Numbej3-- _ f
Ocean Hazard Estuarine Shoreline V_ ORW Shoreline
Public Trust Shoreline Other _
(For official use only)
Ta^
?6_YctA
;;��
� 33 DC & U 7
GENERAL INFORMATION
LAND OWNER
Name w Y1
Address U, l �irurn w noc1 Dr. 'Se
City State _!�\ L Zip _cSLQ.)2hone�—
Email
AUTHORIZED AGENT
Name
Address
City
Email
State
Zip Phone
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the. name of the
adjacent waterbody.) jt�{l c,P:)E �( %l"t' t� ,Tt- nwCx � Dr. 3L t � \3 I u �lL
Lz is wWo rrol ly
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
SIZE OF LOT/PARCEL: square feet i 3 ___� acres
PROPOSED USE: Residential 0" (Single-family ❑ Multi -family ❑ ) Commercial/Industrial ❑ Other ❑
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: 35 Z square feet (includes the area of the roof/drip line of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stotmwater
Management Permit issued by the NC Division of Water Quality?
YES NO
If yes, list the total built upon area/impervious surface allowed for your lot or parcel:
square feet.
REcJ _ivED
RECEIVED
DCM WILMINGTON, NC SEP 2 9 2017
S E P 2 9 2017

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
Al' 1 �i{k
an owner or record title, Title is vested � r C��'l , see Deed Book
page in the = rl_;rNS�,V IL _ County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(1)
(2)
(3)
(4)
ACKNOWLEDGEMENTS:
I, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and fioodproofing techniques.
I furthermore certify that I am authorized to grant, and do in fact grant, permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application.
RECI IVIED
This the _ day of�l� .. MJblfijN, NO
n
S E P 2 9 2017
or person authorized to act as his/her agent for purpose of filing a CAMA permit application
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a check for $100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action.
RECEIVED
SEA 29 7017

4; v rt
r+
© I! 2 gs V
dive way l T.
CO
3TU
hone. FAy
e, IN
5' 3
6use.
t 4 Qr',V('.6rlalY'
ID lot); 4.
QrwhsW;C��
4-3 I Ww$ar L M C
SraY► woo0 D►- 5 E
IVEU�-._._
DCM WILMINGTON
SEP 2 9 201,

' -1
Dale i___
rrm'1rk- Burne-ii
Adjacent Property Owner
Mailing,Address
City, State, Zip Code
Dear Adjacent Property:
ru
u1
1-1.
�
rl (t$
..
_-r
Postage
$ �c
y,.r•-•
r'� AN,%f-"- 22
. j £t t
1
n.l Certified Fee
ti ''
p
p
Return Receipt F a
C
p,*E
-
O
(Endorsement Required)'.)
C3
O
Restricted Delivery Fee
(Endorsement Required)
NS
Er
rU
p Total Postage & Fees
C7
sent To�,�^
p
$rree7. Opt. No.1 (� �� _y /�, ,,,y�, /'-•(�..........................
Iwo of PO Box No.I�[ o i�T143J i_{I_
A i..d�uSr_`_...0
if, State, +4 W i!:I✓
�!�J" .........
This letter is to inform you that I, w - A-11&rsh have applied for a CAMA Minor
Property Owner
Permit on my property at �1 3 _-KnsnwCyz) D( 5 6 , In
COUNTY Property Address
Brunswick County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s) as notification of my proposed project. No action is required from you or you may sign and
return the enclosed no objection form. if you have any questions or comments about my proposed project,
please contact me at •b__a-lp 1- 3'�' l D or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Brunswick County CAMA Minor Permit Program, you may submit
them to:
Sincerely,
pp UU t rc),ft-Cc
Property Owner
;3. (.00e 61 IDS sot
Mailing Address
City, State, Zip Code
Connie Marlowe
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
RECEIVED
DCIVI IVED
DCIVi WILMINGTON, NC
SEP 2 9 2017

Date Fitt. �,l�e_ 61CLL4 --
Adjacent Pro erty Owner
5 5 3 to I ranee rr r.
Mailing Addre s
LO t r t nc,J im ,. NC �Lkq 03
City, State, Zip Code
Dear Adjacent Property:
ru
(Domestic Mail Only;
No r7overage
Provided)
ru
For delivery information
visit our vieb site at
www.0 sps. com-)
m
_
$
.:I-
Postage
-. �c
z2
+y
r1J
Certified Fee)3
p
R
0
Return Receipt FeePost
(Endorsement Required)
C3
Restricted Delivery Fee
p
(Endorsement Required)
ru
Total Postage & Fees
0Pi 10 _'� i'II 7
ent 10
-
C-
orPOS------ — ----
ri3v .RWM Z7P-1
--1 V__1&C-1.2
VA --------------
This letter is to inform you that I, J oe, w - ,-Aa s�) have applied for a CAMA Minor
Property Owner
Permit on my property at r-1 -_3 ) —t- V_c_nU0W(_� Dr, �S t in
COUNTY Property Address
Brunswick County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s) as notification of my proposed project. No action is required from you or you may sign and
return the enclosed no objection form. If you have any questions or comments about my proposed project,
please contact me at IDS �— 3� j , or by mail at the address listed below. Ifyou wish to
Applicant's Telephone
file written comments or objections with the Brunswick County CAMA Minor Permit Program, you may submit
them to'.
Connie Marlowe
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
Sincerely,
yV
Property Owner
3t���s EFLl u.ssorn
Mailing Address
�(AiiE }evi t1�- ► E
c. o 1 stm AAA0s hh]
I3ECCAVED
DCM WILMINGTON, NC
City, State, Zip Code
S E P 2 9 2017

A • .
Brenda m N. Cleons Register of Deeds
08-07-2015 12:38:05.000 Brunswick County, NC
NC REVENUE STRAP: $240.00 (k447745)
1111111111111111111111111111111111111 83674 P1157 P�
Brunswick County, NC Register of Deeds page I of 1
1&--,
U� _
"'ry�lrtl2alwr!?'>gFc�-i`4 'r. - of
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: 24$ 0.00
Parcel Identifier No.: 223DC007
Mail after recording to: The Gordon Law Firm PLLC P.O. Box 2283, Shallotte, NC 28459
This instrument was prepared by Kiersten M. Gordon The Gordon Law Firm PLLC
Delinquent taxes, if any, are to be paid by the closing attorney to the Brunswick County Tax Collector
upon disbursement of the closing proceeds.
Brief description for the Index: Lots 262 & 263 Addition 10 in the Sunset Harbor Development
THIS DEED made this:�ti day of —:SAN 2015, by and between
GRANTOR
Rebecca Dodd Parker, single
123 Pine Lane
Rockingham, NC 28379
GRANTEE
Joseph W. Marsh and wife,
Kevin Stoufer Marsh
3608 Blossom Road
Fayetteville, NC 28306
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall
include singular, plural, masculine, feminine or neuter as required by contest.
WITNESSETH, that the Grantor, for Ten and No/100 ($10.00) Dollars and other valuable
consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these
presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel
of land situated in Brunswick County, North Carolina, and more particularly described as follows:
SEE EXHIBIT "A" ATTACHED
RECEIVED
DCM WILMINGTON, NC
SEP 2 9 2017

Ii1101IlllllJill 11111111111111111111 83674 Piz561238: 6.PROP
arunsuick County, NC Register of Deeds page 2 of 3
The Property is not the primary residence of Grantor.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances
thereto belonging to the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the
right to convey the same in fee simple, that title is marketable and free and clear of all encumbrances,
and that Grantor will warrant and defend the title against the lawful claims of all persons whomsoever
except for the exceptions hereinafter stated.
Title to the property hereinbefore described is subject to the following exceptions:
1. Any and all easements, and public and private utility or rights of way of record or
otherwise affecting said property.
2. Ad valorem taxes for the current and subsequent years.
3. Subject to all restrictions, limitations and reservations of record and as amended and
supplemented from time to time.
IN WITNESS WHEREOF, the Grantor(s) have hereunto set their hands and seals, the day and
year first above written.
(Seal) (Seal)
iebtl'a6�D�odrker
(Seal) (Seal)
STATE OF NORTH CAROLINA
COUNTY OF 110 l C11
This the day of JU " 2015, personally appeared before me Rebecca Dodd
Parker, who being duly sworliand personally known to me or I have seen satisfactory evidence of the
above named person(s) by state or federal photograph identification (a credible witness
has swom to the identity of the principal(s)) each acknowledging to me that helshelthey voluntarily
signed the foregoing document for the purpose stated therein and in the capacity indicated: Rebecca
Dodd Parker.
Date:
O cial Signature of Notalry ,Publlic
a s (Notary's Printed or Typed Name)
? r" �QTAR a
My commission expires: c b b
RECEIVED
DCM WILMINGTON, NC
S E P 2 9 2017

81181IIIIIIIIIIIIIIIIIIIiIIIIIlIIII a�s�� Pile a ° - '�0
Brenda CI. Claanons PROP
Brunswick County, NC Register of Deeds page 3 of 3
Exhibit "A"
Being all of Lots 262 and 263 of Addition 10 in the Sunset Harbor
Development as shown on a map recorded in Plat Book 10 at Page 95 of
the Brunswick County Registry.
This conveyance is made subject to the covenants, conditions and
restrictions as set forth in Book 372 at Page 670 and Book 474 at Page
810, Brunswick County Registry.
Deed Reference: Book 1274 at Page 661 and Estate File # 06 E 205
Parcel # 233DC007
Property Address: 431 Ironwood Drive SE, Bolivia, NC 28422
RECEIVED
DCM WILMINGTON, NC
S E P 2 9 2017

Brunswick County Health Department
Environmental Health Section Application # 199AO740
Alternative Sewage Treatment and Disposal System Tax Parcel # 233DC007
System Type — IVA
AUTHORIZATION TO CONSTRUCT `
R
WASTEWATER COLLECTION, TREATMENT, AND DISPOSAL SYSTEM
Existing System/Re-use Permit
In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina as amended,
AND other applicable Laws and Rules
Owner -Joseph Marsh
Address 3608 Blossom Rd.
Fayetteville NC 3082 g
PERMISSION IS HEREBY GRANTED TO
to construct, install a sewage treatment and disposal system as described below:
To Serve: Residential _3—
# Bedrooms _ Commercial _ #Employees N/A Max. Occupancy _6_
Comments, Description: 3 Bedroom SFD 360 Gallons Per Dav
ADDRESS/LOCATION: 431 Ironwood Dr. SEBoliviaNC28422
The system components consists of: Type system —Pump to Low Pressure Pipe Septic System
Design Flow -- 3_ _ 60 GPQ
I. COLLECTION SYSTEM: CONVENTIONAL_ PLUMBING
(MUST COMPLY WITH ALL APPLICABLE STATE AND LOCAL PLUMBING CODES)
If. TANKAGE: A. SEPTIC TANK(S) 1000 GALLONS CAPACITY (2 existing tanks)
B. PUMP TANK 1000 GALLONS CAPACITY
D. OTHER:
ALL TANKS, FORCE MAINS, PRESSURE LINES TO BE LEAK TESTED AND CERTIFIED BY APPROPREIATE
PARTIES. -Ail tanks and risers shall be tested to be watertight by a 24 hour hydrostatic leakage test conducted at the
site prior to system startup. A water level change of +/_ y2 inch or more over 24 hours, or visual observation of leakage
shall be cause for failure of the test.
ACCESS RISERS REQUIRED ON ALL INSPECTIONS & SERVICE HATCHES ON TANKS -RISERS TO EXTEND 4-6"
ABOVE FINISHED GRADE
Ill. PUMP CHAMBER/DOSING TANK: 1000 gallons
A. DOSING PUMP(S): SIZE, MAKE, MODEL— #: 1 _ Zoeller E-55 for equal) 15 qpm @ 1 NUMBER OF PUMPS REQUIRED. One �' tdh
B. DISCHARGE PIPING: SIZE: 1.5 INCH MATERIAL: SCH 40 PVC GATE VALVES: YES INTERNAL
CHECK VALVE: YES UNION/DISCONNECT: YES
.ANTISIPON HOLE: YES (3/1g1N � PVC LIFT CHAIN OR ROPE. YES
C. DOSE VOLUME:. 120 gallonNON-CORROSIVE
gallons/dose DRAW DOWN DEPTH: 5.0
V.
DOSING MAIN: SIZE: 2 INCH MATERIAL INCHES 3 # of doses per day
SCH 40 PVC INCHES
V. CONi ROL PANEL: Rhombus 112W114H15A 10E170 or equal
TO INCLUDE: NEMA 4X_ENCLOSURE, MANUAL DISCONNECTS/BREAKERS FOR PUMP AND ALARM
(SEPARATE CIRCUITS FOR PUMP AND ALARM), H-O-A SWITCH, ALARM (AUDIBLE AND VISIBLE)
SIMPLEX _ yes WITH ALTERNATOR AND ELASPED TIME COUNTERS / EVENT COUNTERS
OFF 16.00 inches ON es (21.0 inches) ALARM / LAG es 33 inches
(MUST COMPLY WITH ALL APPLICABLE STATE AND LOCAL ELECTRICAL CODES)
VII. DISPOSAL. FIELD: LTAR 0.5 opd/sgq
TYPE IVA: TRENCH DEPTH 18_ inches
This system shall be installed level.
18 inches below existing soil surface
permit.aut
5/97
The Left Rear Corner Iron Rebar is Bench Mark. Each line shalttb i6taftAV E D
. Reference pump plans for elevations.
IJI.;h,w:IILMINGTON, NC
S E P 2 9 2017

Comment: Low Pressure Pipe System. Refer to attached plans submitted from Milliken Pump Company for
ssrstem specifications.
The Owner shall be subject to the following conditions, limitations, and construction requirements for the installation of this
system:
1. This authorization is effective only with respect to the specific design flow and facilities, and the nature and volume of
waste described in the Permit Application, and other supporting data.
2. This permit is not transferable and must be reapplied for at such time as ownership, or management changes.
3. The designated repair area is to have no parking, driveways, or other impervious material located on it. This
area is to be protected, reserved and maintenance in a natural state.
4. All subsequent owners of this property and sewage system, shall execute a contract between the owner and an
approved management entity before the operations permit is issued. Management of the sewer system to be
provided at all times.
5. All contracts between owners, management entity (Public or Private), or Health Dept. shall be reviewed and approved
before being accepted.
6. A properly certified Operator shall be provided as indicated:
Certified Subsurface System Operator: YES
7. The issuance of this permit does not preclude the permittee from complying with any and all statutes, regulations, or
ordinances which may be imposed by other government agencies which have jurisdiction, or any other permits issued
by this department.
8. This wastewater system shall be installed by a contractor authorized in writing by the manufacturer, who shall
coordinate the installation with the designer and the manufacturer's field representative.
9. For rites requiring evaluation by a certified soil scientist or professional geologist, said soil scientist / geologist shall be
present and supervise any site modifications, and critical phases of the wastewater system installation.
10. This authorization shall be valid for 12 months from the date of issue. The authorization shall become invalid if the
information submitted in the application was falsified or changed, if the permit was based on inaccurate or incomplete
information, or if the designated site is altered, or expiration of this authorization, a new application shall be submitted
to the BCHD with updated information, as may be applicable or requested.
11. ** A PERMANENT BARRIER SHALL BE PROVIDED AND IN PLACE AROUNDTHE SYSTEM/REPAIR AREA
BEFORE THE OPERATIONS PERMIT IS ISSUED.
12. ALL APPLICABLE SETBACKS SHALL BE MAINTAINED, NO IRRAGATION SYSTEMS, STORM WATER PONDS /
BASINS, SURFACE/SUBSURFACE DRAINAGE SHALL BE LOCATED IN THE AREA OF THE WASTEWATER
SYSTEM OR ITS REQUIRED SETBACKS,
INSTALLATION REQUIREMENTS
1. The installer shall be currently registered with this department.
2. A pre -installation conference is to be held on the site prior to beginning any site modification or construction of the
Proposed structure or the sewage collection, treatment, and disposal system. Attending these conferences shall be
representatives of the State &/or Local Health Department; project engineer or designer; contractor; builder; proposed
system operator/installer; and the owner or his authorized agent.
3. The contractor shall be responsible for notification of the engineer and the BCHD for system inspection in stages as
required and prior to backfrlling any portion of the system. No portion of the system shall be backfilled or placed into
use without prior approval of the BCHD.
4. The system shall be installed in accordance with the approved set of plans and specifications. Any deviation in site
modifications, plans, specification, layout, materials or other system component shall be approved by the design
engineer and the Brunswick County Health Department prior to installation of the system. Fa r� t� do sq riy,cesult
in delay or refusal of final approval of the system, and may render the Permit null and void .r t �CC1 I- v � 0
5. The system shall be installed in a timely manner and staged so as to avoid unnecessary ex{�5r3tJ[�+ WeAJPN, NC
permit.aut Z S E P 2 9 2017
5197

responsibility of the installer.
7. Other
OPERATION PERMIT REQUIREMENTS
1. An Operation Permit shall be issued by the BCHD prior to placing the system into use, or making any connections to
the system.
2. Prior to issuance of the Operation Permit:
the system shall be completed, installed, and tested in accordance with the approved design, including proper
abandonment of tanks existing wells, and other components. The certified subsurface system operator for the
system shall be present for the testing and startup of the installation.
final landscaping, water diversion devices, and vegetative cover requirements and pressure adjustment shall be
completed,
the Engineer, Designer or applicable responsible parties shall submit as -built plans to the BCHD, the plans shall
reflect any changes or alterations from the as -approved plans. The final pump delivery rate for the installation
shall also be determined and provided to BCHD as part of the final certification.
3. For sites that required evaluation by a certified soil scientist or professional geologist, a written certification shall be
submitted that the site / system installation was / is in accordance with their specified site/installation requirements.
4. For systems that have been engineered or designed by a private consultant , the designer or engineer (as applicable)
shall certify in writing to the Brunswick County Health Department, that he has inspected the installation and that it has
been installed according to the approved plans and specifications.
- Any necessary easements, plats, or other documents shall be recorded with the Register of Deeds and copies
submitted to the BCHD,
- The owner and a Public Management Entity/Subsurface System Certified Operator shall execute a contract which
addresses all of the requirements for maintenance, monitoring, and reporting in Section .1961 and the
requirements of the Schedule of Operation and Maintenance to be a part of the Operation Permit for the facility.
Provisions of said contract shall be in effect for as long as the system is in use.
FLOATS MUST BE ADDED AND INSPECTED PRIOR TO ISSUANCE OF OPERATIONS PERMIT
CONTROL PANEL MUST BE ADDED AND INSPECTED PRIOR TO ISSUANCE OF OPERATIONS PERMIT
SUBSURFACE WASTEWATER OPERATOR IS REQUIRED
NOTICE OF EXPIRA-PON THISAUTHORIZATTON EXPIRES 5YEARS (60 MONTHS) FROM DATE OF THIS PERMIT, IF EXPIRATION
OCCURS, THE CLIENT SHALL COMPLY WITH ALL CHANGES IN APPLICABLE REGULATIONS, LAWS, TECHNICALASPECTS,
ETC., THAT MAY BE EFFECTIVE AT THAT TIME. (THIS MAY REQUIRE ADDITIONAL PREPARATION, MORE COMPLEX
WASTEWATER SYSTEMS. OPERATION AND MAINTENANCE REQUIREMENTS, PRE-TREATMENT, ETC. THIS COULD RESULT IN
LESS ARIA FOR THE HOME, PARKING; LOWER WATER USAGE AND FURTHER DEVELOPMENT UMITATIONS.
BRUNSWICK COUNTY HEALTH DEPARTMENT ALTERNATIVE SYSTEM IMPROVEMENTS
PERMIT/OPERATION PERMIT BCHD # 1995-40740
nEC; ►V ED
DCM WILMINGTON, NC
SEp 2 g loll
permit.aut
5/97

Plan review by Bruce Withrow DATE 2/28/1995
Site evaluation by: Alex Pipes _ DATE _ July 27, 2017
Site modifications, completed and inspected by DATE
AUTHORIZATION TO CONSTRUCT ISSUED THIS _31 DAY OF July 2017
BRUNSWICK COUNTY HEAL RTMENT E ONMENTAL HEALTH DIVISION
PERMIT EXPIRATION DATE: 7/31/2018
****Required****
Pre -construction conference for site by: Before installing system
Date:
Present for conference(list):_ Brunswick County Health Department and Septic Contractor
Pre -construction conference for construction of system by: Date:
Present for conference (list):
riECEIVED
DCM 1A/II MIN(;TON, NO
SEP 2 9 ''UI!
permit.aut 4
5/97

BrunsvAck County Health Services
�j 25 Courthouse Drive N.E.: Post Office Box 9
�tiyo Bolivia, North Carolina 2S422-0009
CA no`�=- 910-253-2250 1-SSS- {?S a L29 Norih Carol
ip
Public Health
Darid _i!. Stanter III, Erectrtire Dbrcton-
FieatrJt anditttuatc Sen rceS _igetrc}• Ci•is H017clsou, Ditrctor
Department ojHealth Sen•ices
Site Plan For (Check One): ❑ Improvement Permit ❑ Fill Plan Authorization to Construct Permit
Date:
ElWell Permit ❑ Proposal
BCHS #: 1995040740A
Tax Parcel #: 233DC007 --
REHS Signa re
*SITE .PLAN ONLY. THIS IS NOT A Pri kMIT*
1Zt
g� eo�C,
33
� 2k
5
DPP
25' 17
( aIr
XV
y t
4
r _
3A(
R oti woo > pRwE
t— iVED
r)r,'M WILMINGTOf�,
SEP 2 9 2011